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<table width="700px" align="center" cellpadding='0' cellspacing='0'>
<tr><td height="100" class="STYLE2" align="center">商户信息及终端变更申请表
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<table width="700px" align="center" cellpadding='5' cellspacing='0' class="linetable">
<tr><td class="linetd" height="30" colspan="7" align="right" >申请日期：generatedate</td></tr>
<tr bgcolor="#999999"><td class="linetd_grey" height="30" colspan='7'><strong>第一部分：合作机构基本信息</strong></td></tr>
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  <td class="linetd" height="30" colspan='7' >合作机构名称：现在（北京）支付股份有限公司</td>
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<tr><td class="linetd" width="14%" >主要联络人：</td>
<td class="linetd" width="14%" height="30">王大伟</td>
<td class="linetd" width="14%" >电话：</td>
<td class="linetd" width="14%" height="30" >18501865550</td>
<td class="linetd" width="14%" >传真：</td>
<td class="linetd" width="30%" height="30" colspan='2'>010-12345678</td>
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<tr><td class="linetd" >电子邮箱：</td><td class="linetd" height="30" colspan='6' >service@ipaynow.cn </td>
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<tr><td class="linetd" >邮寄地址：</td>
<td class="linetd" height="30" colspan='6' >北京市西城区宣武门内大街庄胜中央办公楼北翼923室</td>
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<tr><td class="linetd_grey" height="30" colspan='7' ><strong>第二部分：变更信息说明</strong></td></tr>
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  <td class="linetd" width="14%"><span>商户名称：</span></td>
  <td class="linetd" height="30" colspan='2'>mhtname</td>
  <td class="linetd" width="14%"><span>商户编号：</span></td>
  <td class="linetd" height="30" colspan='3'>mhtno</td>
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<tr><td class="linetd" height="30">新增终端</td><td class="linetd" colspan='6' >新增终端数量：</td>
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<tr><td class="linetd" height="40" colspan='7' align="center" ><strong>变更信息详情</strong></td></tr>
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<td class="linetd" >变更选项</td>
<td class="linetd" height="30" colspan='3' align="center" >变更前信息</td>
<td class="linetd" height="30" colspan='3'align="center" >变更后信息</td></tr>
<tr><td class="linetd" >账户名称</td><td class="linetd" height="30" colspan='3' ></td>
<td class="linetd" height="30" colspan='3'></td>
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<td class="linetd" >结算账号</td><td class="linetd" height="30" colspan='3' >settleAccno</td>
<td class="linetd" height="30" colspan='3'>accno</td>
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<td class="linetd" >开户行名称</td>
<td class="linetd" height="30" colspan='3' ></td>
<td class="linetd" height="30" colspan='3'> </td>
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<tr><td class="linetd" >开户行号</td><td class="linetd" height="30" colspan='3' ></td><td class="linetd" height="30" colspan='3'></td></tr>
<tr><td class="linetd" >费率</td><td class="linetd" height="30" colspan='3' > </td><td class="linetd" height="30" colspan='3'></td></tr>
<tr><td class="linetd" >变更理由</td><td class="linetd" height="30" colspan='6' > </td></tr>
<tr><td class="linetd" >商户名称</td><td class="linetd" height="30" colspan='3' ></td><td class="linetd" height="30" colspan='3'></td></tr>
<tr><td class="linetd" >经营地址</td><td class="linetd" height="30" colspan='3' ></td><td class="linetd" height="30" colspan='3'></td></tr>
<tr><td class="linetd" >商户对账单</td><td class="linetd" height="30" colspan="6" ></td></tr>
<tr><td class="linetd" height="30">法人</td><td class="linetd" height="30" colspan='3' ></td><td class="linetd" height="30" colspan='3'></td></tr>
<tr><td class="linetd" height="30" colspan='7' >变更申请提交人：</td></tr>
<tr><td class="linetd" height="100" colspan='7' >公司盖章：</td></tr>
<tr><td class="linetd" height="30" colspan='7' align="right" >日期： generatedate</td></tr>
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